Healthcare Provider Details

I. General information

NPI: 1053176768
Provider Name (Legal Business Name): TYLER LYONS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 W JUDGE PEREZ DR
CHALMETTE LA
70043-4500
US

IV. Provider business mailing address

1224 SAINT CHARLES AVE APT 204
NEW ORLEANS LA
70130-4388
US

V. Phone/Fax

Practice location:
  • Phone: 504-277-4401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7813
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: